ATI PHARMACOLOGY NSG 1540 EXAM 3
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Free ATI PHARMACOLOGY NSG 1540 EXAM 3 Questions
A nurse is teaching a new nurse about safe medication administration. Which action demonstrates that the new nurse understands how to reduce medication errors?
- Verifying the client's identity with two forms of identification.
- Asking the client to state their diagnosis before giving the medication.
- Preparing medications for multiple clients at the same time to save time.
- Delaying documentation until the end of the shift.
Explanation
Correct Answer: A) Verifying the client's identity with two forms of identification.
Using two patient identifiers (such as name and date of birth) before medication administration is a core safety standard and a fundamental step in preventing medication errors. Asking a client to state their diagnosis is not a reliable or standard identifier. Preparing medications for multiple clients simultaneously increases the risk of mix-ups and errors. Delaying documentation until the end of the shift compromises accuracy, continuity of care, and safety.
A client has been diagnosed with Clostridioides difficile infection after completing a 10-day course of broad-spectrum antibiotics. Which nursing actions are appropriate? (Select all that apply.)
- Place the client on contact precautions
- Encourage the client to increase fluid intake
- Use dedicated equipment (e.g., stethoscope, blood pressure cuff) for this client
- I will take a probiotic supplement during and after the antibiotic course
- Instruct the client to perform hand hygiene using an alcohol-based hand sanitizer
- Administer loperamide to reduce diarrhea
Explanation
Correct Answers: A) Place the client on contact precautions, B) Encourage the client to increase fluid intake, and C) Use dedicated equipment for this client.
C. diff is transmitted via the fecal-oral route through spores, so contact precautions and dedicated equipment are essential to prevent spread. Increasing fluid intake addresses dehydration from diarrhea. Alcohol-based hand sanitizers are ineffective against C. diff spores — soap and water must be used instead, making option E incorrect. Loperamide is contraindicated in C. diff as it slows gut motility and can worsen the infection by retaining toxins. Probiotics (option D) are a patient statement, not a nursing action, and while sometimes discussed adjunctively, they are not a standard approved nursing intervention for active C. diff infection.
A nurse is caring for a client who is receiving gentamicin. Which of the following findings should the nurse identify as a possible complication?
- Dysuria
- Ototoxicity
- Constipation
- Diplopia
Explanation
Correct Answer: B) Ototoxicity
Gentamicin is an aminoglycoside antibiotic with well-established dose-dependent toxicities, the most serious of which are ototoxicity and nephrotoxicity. Ototoxicity results from damage to the hair cells of the cochlea and vestibular apparatus, presenting as tinnitus, hearing loss, and balance disturbances. Because this damage can be permanent and irreversible, nurses must monitor drug levels, assess hearing regularly, and watch for early warning signs throughout therapy.
Dysuria relates to urinary tract irritation and is not a characteristic complication of gentamicin. Constipation is not associated with aminoglycoside use. Diplopia — double vision — is linked to conditions such as myasthenia gravis or cranial nerve dysfunction, not gentamicin toxicity.
A nurse is caring for a client who is receiving amoxicillin IV for an infection. The client develops hives and complains of itching. What should the nurse's next action be?
- Stop the amoxicillin immediately and assess the client's airway, breathing, and circulation
- Administer a dose of diphenhydramine to alleviate the rash
- Notify the healthcare provider to discuss alternative antibiotics for the client
- Instruct the client to continue the amoxicillin but monitor the client closely for any further reactions
Explanation
Correct Answer: A) Stop the amoxicillin immediately and assess the client's airway, breathing, and circulation
Hives and itching during IV antibiotic administration are signs of an allergic reaction that can rapidly progress to anaphylaxis — a life-threatening emergency involving airway compromise, bronchospasm, and cardiovascular collapse. The nurse's immediate priority following the ABC (Airway, Breathing, Circulation) framework is to stop the infusion at once to prevent further allergen exposure, then rapidly assess for signs of anaphylaxis such as stridor, hypotension, or angioedema.
Administering diphenhydramine and notifying the provider are appropriate subsequent steps but only after stopping the medication and completing the primary assessment. Continuing the amoxicillin would be a dangerous error, as the allergic reaction could escalate to a fatal anaphylactic response with continued exposure.
A client taking mycophenolate (CellCept) for the prevention of organ rejection expresses concern about side effects. Which statement by the nurse is most accurate?
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"This medication may cause severe hypertension; monitor your blood pressure closely."
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"You can switch between Myfortic and CellCept depending on availability."
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"This medication has a safety alert for causing birth defects and pregnancy loss."
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"The most serious adverse effect is orthostatic hypotension."
Explanation
Correct Answer: C) "This medication has a safety alert for causing birth defects and pregnancy loss."
Mycophenolate (CellCept) carries a black box warning for teratogenicity — it is a known human teratogen associated with a high risk of first-trimester pregnancy loss and serious congenital malformations including cleft palate, ear, and limb abnormalities. Female patients of childbearing age must use two reliable forms of contraception before starting, during, and for six weeks after stopping therapy. This critical safety alert must be clearly communicated to all patients receiving this immunosuppressant.
While hypertension can occur with some immunosuppressants, it is not the primary safety concern with mycophenolate. CellCept and Myfortic are not interchangeable — they have different pharmacokinetic profiles and bioavailability, and switching without provider guidance is unsafe. Orthostatic hypotension is not a recognized serious adverse effect of mycophenolate therapy.
A nurse is caring for a client who has sepsis and a prescription for vancomycin 1 g in 250 mL dextrose 5% (D₅W) over 2 hr by IV intermittent bolus. The nurse should set the IV pump to deliver how many mL/hr?
Explanation
Correct Answer: 125 mL/hr
To calculate the IV flow rate, use the formula: Volume (mL) ÷ Time (hr) = Rate (mL/hr). The total volume is 250 mL and the infusion time is 2 hours. Therefore: 250 mL ÷ 2 hr = 125 mL/hr. No trailing zero is used, and no leading zero is needed as the answer is a whole number greater than one. The nurse should set the IV pump to 125 mL/hr to deliver the vancomycin safely over the prescribed 2-hour period.
A nurse is preparing to administer IV ketorolac to a client who has postoperative pain. Which action should the nurse take before administering the medication?
- Mix the medication with a narcotic IV pain medication for synergistic effect.
- Confirm the client's renal function is within normal limits.
- Administer the medication quickly to provide immediate pain relief.
- Administer the medication before checking the client's vital signs to address the client's pain promptly.
Explanation
Correct Answer: B) Confirm the client's renal function is within normal limits.
Ketorolac is an NSAID that can cause nephrotoxicity, particularly with repeated dosing. Confirming normal renal function before administration is essential to ensure client safety. Ketorolac should never be mixed with opioids in the same syringe as precipitation may occur. It should be administered slowly, not quickly, to reduce adverse effects. Vital signs must always be assessed before medication administration — skipping this step is unsafe practice.
Which instruction should a nurse give to a client who is prescribed clotrimazole vaginal tablets for treatment of candidiasis?
- Insert the tablet at bedtime to reduce leakage
- Apply the medication to external lesions only
- Use tampons during therapy to absorb excess discharge
- Discontinue the medication once symptoms improve
Explanation
Correct Answer: A) Insert the tablet at bedtime to reduce leakage
Clotrimazole vaginal tablets should be inserted at bedtime so the patient remains recumbent for several hours, allowing the medication to dissolve and distribute throughout the vaginal canal without leaking out due to gravity and activity. This maximizes the drug's contact time with the affected mucosa and improves therapeutic effectiveness against the Candida infection.
Clotrimazole vaginal tablets are formulated specifically for intravaginal use, not for application to external lesions — a separate topical cream is used for external symptoms. Tampons should be avoided during therapy as they absorb the medication and significantly reduce its effectiveness. The full prescribed course must be completed even if symptoms resolve early, as stopping prematurely risks recurrence and the development of antifungal resistance.
A nurse is caring for a client who is receiving basiliximab (Simulect) as part of an immunosuppressive regimen following a kidney transplant. Which finding should the nurse recognize as a potential indication of cytokine release syndrome?
- Gradual weight gain over several weeks
- Increased appetite and insomnia
- Sudden onset of fever and chills
- Constipation and abdominal bloating
Explanation
Correct Answer: C) Sudden onset of fever and chills
Cytokine release syndrome (CRS) is an acute systemic inflammatory reaction that can occur following administration of monoclonal antibodies such as basiliximab. It results from massive release of pro-inflammatory cytokines into the bloodstream, triggering a rapid systemic response. The hallmark presentation includes sudden onset of fever and chills, often accompanied by hypotension, tachycardia, dyspnea, and rigors. This is a medical emergency requiring immediate intervention including stopping the infusion and providing supportive care.
Gradual weight gain over weeks is more consistent with fluid retention or corticosteroid side effects, not CRS. Increased appetite and insomnia are common corticosteroid side effects unrelated to cytokine release. Constipation and abdominal bloating are gastrointestinal symptoms with no direct association with cytokine release syndrome.
A nurse is evaluating the effectiveness of allopurinol therapy for a client who has chronic gout. Which laboratory finding indicates the medication is achieving the desired therapeutic effect?
- White blood cell count of 11,000/mm³ (Reference range: 4,000–11,000/mm³)
- Serum creatinine level of 1.4 mg/dL (Reference range: 0.6–1.2 mg/dL)
- Serum uric acid level of 5.8 mg/dL (Reference range: 3.5–7.2 mg/dL)
- Blood glucose level of 130 mg/dL (Reference range: 70–110 mg/dL)
Explanation
Correct Answer: C) Serum uric acid level of 5.8 mg/dL (Reference range: 3.5–7.2 mg/dL)
Allopurinol works by inhibiting xanthine oxidase, thereby reducing the production of uric acid. A serum uric acid level within the normal reference range indicates the medication is achieving its therapeutic goal of preventing hyperuricemia and gout attacks. A normal WBC count does not reflect allopurinol's effect. An elevated creatinine suggests possible renal impairment, which is a concern with allopurinol use, not a therapeutic effect. An elevated blood glucose is unrelated to allopurinol therapy.
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